The medical profession now broadly recognizes that there is much more to good health than having affordable access to excellent medical care. In particular, housing difficulties are seen as comprising an important determinant in the underlying health condition of many families, and they often are a factor in acute episodes of illness. Poor living conditions can trigger such developments as respiratory problems and stress-related illness, and many falls and hospitalizations among elderly individuals result directly from unsafe housing.
Action and Obstacles
As Howard Koh, MD, MPH, and Robert Restuccia, MPA, wrote last year in a JAMA Forum, the health care community is increasingly partnering with local organizations and housing advocates to address housing issues, including homelessness, that contribute to ill-health. The National League of Cities, the National Governors Association, and other bodies are identifying best practices for state and local lawmakers and officials seeking to use housing to help improve health outcomes and save money. Meanwhile, the body of research on health and housing is growing; the University of California, San Francisco, maintains an online library tracking the expanding research literature on the connection between health and investments in social sectors, such as housing.
Despite this attention, there are obstacles to making full use of housing as a social determinant of health. Because of such factors as privacy concerns and simple bureaucratic inertia, for instance, the sharing of data needed for successful partnerships often does not occur. An even bigger problem is that many potential partnerships encounter the “wrong pocket” problem, in which the bankable savings associated with a health-related investment in the housing budget show up in another sector—the health budget—rather than in the housing sector’s bottom line. This makes it hard to gain support from housing agencies for investments to promote health.
Promoting Housing-Health Partnerships
So how can we encourage investment in housing to improve health and avoid some medical costs?
In a recent Brookings report I coauthored, we explored ways to do this. In addition to tackling some of the general issues that impede cross-sector partnerships, such as the problem of sharing data, we identified a number of specific steps that would foster housing-health partnerships. In particular, we identified several possible solutions to the wrong pocket problem and other budget and payment disincentives.
To read the entire article by Stuart Butler, go here.
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